Discussion of public health and health care policy, from a public health perspective. The U.S. spends more on medical services than any other country, but we get less for it. Major reasons include lack of universal access, unequal treatment, and underinvestment in public health and social welfare. We will critically examine the economics, politics and sociology of health and illness in the U.S. and the world.

Tuesday, November 20, 2007

The Age of Denial

John Kenneth Galbraith's popular economic history of the first part of the 20th Century is called The Age of Uncertainty. My history of the present era -- once I get done with the other three books I keep meaning to write -- will be called The Age of Denial.

The presidential campaign we are now enduring is utterly surreal. Barack Obama, rightly, has gotten a major wacking for talking about a Social Security crisis, when there actually isn't one. But helloooooooooo Barack, Hillary, John, Chris, all you characters -- there really are crises out there, major problems that we need to acknowledge and get to work on. I don't expect the Republican candidates to be connected in any way to reality, but somebody has to be.

Medicare and Medicaid: Yes, a for real, honest to gosh, big bad crisis, embedded in the broader crisis of a dysfunctional and increasingly unaffordable health care system in genera. Y'all are talking about various ways of increasing the number of people who have health insurance, but forcing people to buy insurance they can't afford is to ignore the real, fundamental problem. Actually it just makes it worse. Oh yeah, it isn't progressive either.

Debt: Both public and private. Social Security can pretty much pay for itself, with a little tweaking, but the rest of what government does is hugely underfunded. In fact, by any rational accounting, the United States is bankrupt. And so are a lot of it's people, who have been living on credit card and home equity debt. The dollar still has a long way to fall, and all that bad debt is just starting to peek out from the arcane and obscure books of financial institutions. It's gonna get uglier and uglier.

Decaying infrastructure: And while we're living beyond our means, we haven't bothered to maintain the house. All those highways and bridges and water treatment plants and schools and airports and water mains and what all built mostly in the 1950s, and some before that, are ready for the scrap heap. We must pay.

Nuclear weapons: Don't get me started. The problem is not that Iran might get them some day. We need to eliminate the ones that already exist.

Global climate change: Yeah, the Democratic candidates occasionally mention this. They want to make ethanol from corn. Aside from that, nada. In fact, the issue is no longer just carbon emissions -- the horse has left the barn, folks. We need to plan and prepare for the consequences. It is happening, now.

Sustainability of the human population: The price of food is already going up with the price of the fossil fuel used to grow, transport and process it, and now it's going up even more sharply as we start to cook food into fuel. Malthus was actually right, you know -- we just got a break for a century and half or so with the demographic transition in the wealthier countries and rapid technological advances in agriculture. There isn't another ace in that deck, believe me.

Drug resistant pathogens and emerging infectious diseases; grotesque economic inequality in the U.S.; declining real incomes of American workers; the needs of a growing population of elders, including more and more extremely old people; and more stuff I could think of.

We aren't talking about any of this! We're obsessed with a non-existent threat of the Islamofascist movement taking over the world, the moral status of zygotes, the invading brown Mexican hordes who are going to make us all eat tortillas and play giant guitars or something -- in the worst case scenario, they might even get driver's licenses -- and how we can cut taxes on investment income.